Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

I Gede Sutawan; Sri Maliawan; I Wayan Niryana

doi:10.15562/ism.v12i2.1047

Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

I Gede Sutawan ,

Sri Maliawan ,

I Wayan Niryana ,

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DOI: https://doi.org/10.15562/ism.v12i2.1047 |
Published: 2021-08-31

Abstract

Background: Head injury or capitis trauma is a blunt/sharp force to the head or face resulting in temporary or persistent cerebral dysfunction. From a socio-economic point of view, the prognostic model by looking at baseline data on admission is an important factor in supporting cost-effective clinical decisions. This study aims to evaluate the risk factors that influence outcomes in head injury patients at Sanglah Hospital, Bali, Indonesia, in 2018-2019.

Method: Prospective cohort study to see the effect of risk factors for head injury patients (exposure) with the outcome in the form of unfavorable conditions within 7 days. This research was conducted at the Surgery Department and Emergency Room Sanglah Hospital Denpasar- Bali for 6 months from September 2018-February 2019. Data were analyzed using SPSS version 16 for Windows.

Results: Some of the factors significantly associated with and risk factors for the unfavorable outcome within 7 days in head injury patients who were treated at Sanglah General Hospital in 2018-2019 were hypotension, initial GCS 3-8, anisocoria pupil reflex, hypoxia, focal lesions, midline shift, and length of time operation ? 6 hours (p<0.05). Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients admitted to Sanglah General Hospital (Adjusted OR: 5.4; 95% CI: 2.47-12.07; p=0.000).

Conclusion: Hypotensive blood pressure is the most dominant risk factor for the unfavorable outcome within 7 days of head injury patients treated at Sanglah General Hospital in 2018-2019.

Latar belakang: Cedera kepala atau trauma kapitis merupakan kekerasan tumpul/tajam pada kepala atau wajah yang berakibat disfungsi serebral sementara atau menetap. Dari sudut pandang sosioekonomi, model prognostik dengan melihat data awal saat masuk rumah sakit merupakan faktor penting dalam mendukung keputusan klinis yang cost-effective. Penelitian ini bertujuan untuk mengevaluasi faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

Metode: Studi kohort prospektif untuk melihat pengaruh faktor resiko yang dimiliki pasien cedera kepala (exposure) dengan hasil luaran (outcome) berupa kondisi unfavourable dalam 7 hari. Penelitian ini dilakukan di Bagian Bedah FK UNUD/SMF Bedah Saraf RSUP Sanglah, Denpasar-Bali dan Instalasi Rawat Darurat RS Sanglah Denpasar-Bali selama 6 bulan dari bulan September 2018-Februari 2019. Data dianalisis menggunakan SPSS versi 16 untuk Windows.

Hasil: Beberapa faktor yang berhubungan secara bermakna dan menjadi faktor risiko terjadinya outcome unfavorable dalam 7 hari pada pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019 adalah hipotensi, GCS awal 3-8, reflek pupil anisokor, hipoksia, fokal lesi, midline shift, dan lama waktu tindakan operasi ? 6 jam (p<0,05). Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah (Adjusted OR: 5,4; 95% IK: 2,47-12,07; p=0,000)

Kesimpulan: Tekanan darah hipotensi merupakan faktor risiko yang paling dominan terhadap outcome unfavorable dalam 7 hari pasien cedera kepala yang dirawat di RSUP Sanglah tahun 2018-2019.

References

Gean AD, Fischbein NJ. Head trauma. Neuroimaging Clin N Am. 2010;20(4):527-556.
Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):699- 705.
Adeleye AO, Ogun MI. Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era. Front Neurol. 2017;8:695.
Zamzami NM, Fuadi I, Nawawi AM. Angka Kejadian dan Outcome Cedera Otak di RS. Hasan Sadikin Bandung Tahun 2008-2010. Jurnal Neuroanestesi Indonesia. 2013;2(2):89–94.
Golden N, Niryana W, Mahadewa TGB, Maliawab S, Chandra A. Two Different Approaches in Obtaining Head Computerized Tomography Scan in Minor Head Injuries. J Neurol Res. 2013;3(3-4):114–121.
Suyasa IK, Lestari AAW, Prabawa IPY, Marta KKA. Water sport-related spine injury in Bali: a review and preliminary study. Indonesia Journal of Biomedical Science. 2019;13(2):72-76.
Tjahjadi M, Arifin MZ, Gill AS, Faried A. Early Mortality Predictor of Severe Traumatic Brain Injury: A Single Center Study of Prognostic Variables Based on Admission Characteristics. Indian J Neurotrauma. 2013;10(1):3–8.
Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A. Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry. 2008;79(5):567-573.
Sudarsanan S, Chaudhary S, Pawar AA, Srivastava K. Psychiatric Effects of Traumatic Brain Injury. Med J Armed Forces India. 2007;63(3):259-263.
Park JE, Kim SH, Yoon SH, Cho KG, Kim SH. Risk Factors Predicting Unfavorable Neurological Outcome during the Early Period after Traumatic Brain Injury. J Korean Neurosurg Soc. 2009;45(2):90-95.
Ponsford J. Factors contributing to outcome following traumatic brain injury. NeuroRehabilitation. 2013;32(4):803-815.
Zia N, Mehmood A, Namaganda RH, Ssenyonjo H, Kobusingye O, Hyder AA. Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry. Trauma Surg Acute Care Open. 2019;4(1):e000259.
Andriessen TM, Horn J, Franschman G, van der Naalt J, Haitsma I, Jacobs B, et al. Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. J Neurotrauma. 2011;28(10):2019-31.
Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, et al. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907-11.
Carne RP, Vogrin S, Litewka L, Cook MJ. Cerebral cortex: an MRI-based study of volume and variance with age and sex. J Clin Neurosci. 2006;13(1):60-72.
Grigorakos L, Alexopoulou A, Tzortzopoulou K, Stratouli S, Chroni D, Papadaki E, et al. Predictors of Outcome in Patients with Severe Traumatic Brain Injury. J Neurosci Clin Res. 2016;1(1):1–4.
Middleton PM. Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15(3):170-183.
Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136(10):1118-1123.
Servadei F, Murray GD, Penny K, Teasdale GM, Dearden M, Iannotti F, et al. The value of the "worst" computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium. Neurosurgery. 2000;46(1):70-5.
Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group. J Neurosurg. 1996;85(1):82-89.
Haselsberger K, Pucher R, Auer LM. Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir (Wien). 1988;90(3-4):111-116.
Tito A, Saragih SGR. Perbandingan Glasgow Coma Scale dan Gambaran Midline-Shift CT-Scan Kepala sebagai Prediktor Mortalitas Pasien Cedera Kepala. Cermin Dunia Kedokteran. 2018;45(4):247–63.
Matsushima K, Inaba K, Siboni S, Skiada D, Strumwasser AM, Magee GA, et al. Emergent operation for isolated severe traumatic brain injury: Does time matter? J Trauma Acute Care Surg. 2015;79(5):838-42.
Mollayeva T, Xiong C, Hanafy S, Chan V, Hu ZJ, Sutton M, et al. Comorbidity and outcomes in traumatic brain injury: protocol for a systematic review on functional status and risk of death. BMJ Open. 2017;7(10):e018626.

[1] Gean AD, Fischbein NJ. Head trauma. Neuroimaging Clin N Am. 2010;20(4):527-556.

[2] Golden N, Mardhika PE, Niryana W, Sukarya IM, Prabawa IPY. Risk factors and novel prognostic score for predicting the 14-day mortality of severe traumatic brain injury patients. Intisari Sains Medis. 2020;11(3):699- 705.

[3] Adeleye AO, Ogun MI. Clinical Epidemiology of Head Injury from Road-Traffic Trauma in a Developing Country in the Current Era. Front Neurol. 2017;8:695.

[4] Zamzami NM, Fuadi I, Nawawi AM. Angka Kejadian dan Outcome Cedera Otak di RS. Hasan Sadikin Bandung Tahun 2008-2010. Jurnal Neuroanestesi Indonesia. 2013;2(2):89–94.

[5] Golden N, Niryana W, Mahadewa TGB, Maliawab S, Chandra A. Two Different Approaches in Obtaining Head Computerized Tomography Scan in Minor Head Injuries. J Neurol Res. 2013;3(3-4):114–121.

[6] Suyasa IK, Lestari AAW, Prabawa IPY, Marta KKA. Water sport-related spine injury in Bali: a review and preliminary study. Indonesia Journal of Biomedical Science. 2019;13(2):72-76.

[7] Tjahjadi M, Arifin MZ, Gill AS, Faried A. Early Mortality Predictor of Severe Traumatic Brain Injury: A Single Center Study of Prognostic Variables Based on Admission Characteristics. Indian J Neurotrauma. 2013;10(1):3–8.

[8] Fabbri A, Servadei F, Marchesini G, Stein SC, Vandelli A. Early predictors of unfavourable outcome in subjects with moderate head injury in the emergency department. J Neurol Neurosurg Psychiatry. 2008;79(5):567-573.

[9] Sudarsanan S, Chaudhary S, Pawar AA, Srivastava K. Psychiatric Effects of Traumatic Brain Injury. Med J Armed Forces India. 2007;63(3):259-263.

[10] Park JE, Kim SH, Yoon SH, Cho KG, Kim SH. Risk Factors Predicting Unfavorable Neurological Outcome during the Early Period after Traumatic Brain Injury. J Korean Neurosurg Soc. 2009;45(2):90-95.

[11] Ponsford J. Factors contributing to outcome following traumatic brain injury. NeuroRehabilitation. 2013;32(4):803-815.

[12] Zia N, Mehmood A, Namaganda RH, Ssenyonjo H, Kobusingye O, Hyder AA. Causes and outcomes of traumatic brain injuries in Uganda: analysis from a pilot hospital registry. Trauma Surg Acute Care Open. 2019;4(1):e000259.

[13] Andriessen TM, Horn J, Franschman G, van der Naalt J, Haitsma I, Jacobs B, et al. Epidemiology, severity classification, and outcome of moderate and severe traumatic brain injury: a prospective multicenter study. J Neurotrauma. 2011;28(10):2019-31.

[14] Mosenthal AC, Lavery RF, Addis M, Kaul S, Ross S, Marburger R, et al. Isolated traumatic brain injury: age is an independent predictor of mortality and early outcome. J Trauma. 2002;52(5):907-11.

[15] Carne RP, Vogrin S, Litewka L, Cook MJ. Cerebral cortex: an MRI-based study of volume and variance with age and sex. J Clin Neurosci. 2006;13(1):60-72.

[16] Grigorakos L, Alexopoulou A, Tzortzopoulou K, Stratouli S, Chroni D, Papadaki E, et al. Predictors of Outcome in Patients with Severe Traumatic Brain Injury. J Neurosci Clin Res. 2016;1(1):1–4.

[17] Middleton PM. Practical use of the Glasgow Coma Scale; a comprehensive narrative review of GCS methodology. Australas Emerg Nurs J. 2012;15(3):170-183.

[18] Manley G, Knudson MM, Morabito D, Damron S, Erickson V, Pitts L. Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg. 2001;136(10):1118-1123.

[19] Servadei F, Murray GD, Penny K, Teasdale GM, Dearden M, Iannotti F, et al. The value of the "worst" computed tomographic scan in clinical studies of moderate and severe head injury. European Brain Injury Consortium. Neurosurgery. 2000;46(1):70-5.

[20] Harders A, Kakarieka A, Braakman R. Traumatic subarachnoid hemorrhage and its treatment with nimodipine. German tSAH Study Group. J Neurosurg. 1996;85(1):82-89.

[21] Haselsberger K, Pucher R, Auer LM. Prognosis after acute subdural or epidural haemorrhage. Acta Neurochir (Wien). 1988;90(3-4):111-116.

[22] Tito A, Saragih SGR. Perbandingan Glasgow Coma Scale dan Gambaran Midline-Shift CT-Scan Kepala sebagai Prediktor Mortalitas Pasien Cedera Kepala. Cermin Dunia Kedokteran. 2018;45(4):247–63.

[23] Matsushima K, Inaba K, Siboni S, Skiada D, Strumwasser AM, Magee GA, et al. Emergent operation for isolated severe traumatic brain injury: Does time matter? J Trauma Acute Care Surg. 2015;79(5):838-42.

[24] Mollayeva T, Xiong C, Hanafy S, Chan V, Hu ZJ, Sutton M, et al. Comorbidity and outcomes in traumatic brain injury: protocol for a systematic review on functional status and risk of death. BMJ Open. 2017;7(10):e018626.

Faktor risiko yang mempengaruhi outcome pada pasien cedera kepala di RSUP Sanglah, Bali, Indonesia pada tahun 2018-2019

Abstract

References

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